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PubMed1988

The first American case of myasthenia gravis.

Reported here is an account of the illness of Indian Chief Opechankanough (died 1644), which may represent the first recognized case of myasthenia gravis. Historical publications based on colonial correspondence with England are the sources for this article. To my knowledge, this is the first article in the medical historical literature to mention this famous and influential Indian. Historical accounts state that Opechankanough was so weak as to be unable to walk, making it necessary that he be carried about on a litter. Moreover, his eyelids were so weak they had to be raised by his attendants. Additionally, a hint of improvement in this weakness after rest is suggested by one historical account. The differential diagnosis of Chief Opechankanough's weakness is discussed. The historical setting of this famous chief in Colonial America and Colonial Virginia is described, as well.

Famous Persons↗

PubMed1989

The dream king's psychiatrist Bernhard von Gudden (1824-1886). A life committed to rationality.

Bernhard von Gudden's life is commemorated as being exemplary for a generation of physicians who in the last century established some of the still valid approaches of modern neuroanatomy, neurology, and psychiatry. His personal contribution to neuroanatomy was the experimental method, major technical advances, and the clarification of the fiber course in the optic chiasm. As a psychiatrist he introduced the humanitarian principle of "no restraint" to German asylums. Although he did not attempt to develop a systematic nosology, he nevertheless founded an influential school of psychiatrists (eg, Forel, Kraepelin, and Nissl). For many years Gudden served as consulting psychiatrist to Bavaria's royal family and drowned together with his patient, King Ludwig II, whose sanity had been questioned.

Germany↗

PubMed1986

The status of research in ambulatory pediatrics.

To investigate the status of clinical research in ambulatory pediatrics and to characterize those environments that produce the most research activities and receive funding for research, a questionnaire survey was undertaken of all ambulatory pediatrics programs in the United States and Canada (N = 143). Our response rate was 68%. We found that divisions of ambulatory pediatrics that conduct clinical research have more faculty with formal research training, faculty with more time devoted to research endeavors, a designated research coordinator, research funding, and regular research seminars. Divisions of ambulatory pediatrics that have funding for research have more faculty with formal research training, fellows, a designated research coordinator, and regular research seminars. Funding for research is a more influential factor in producing clinical research than the number of faculty members in the division. The most frequently mentioned barrier to doing research was lack of time. Divisions of ambulatory pediatrics must continue to stress formal research training, faculty time set aside for research, and skills in grant writing if they hope to compete for academic recognition in the years ahead.

Pediatrics↗

PubMed1977

The offspring of schizophrenics. II. Perinatal factors and IQ.

Within a sample of 60 children of schizophrenic parents, IQ and the correlates of IQ were examined. The Wechsler Intelligence Scale for Children was administered at age 7. The offspring of parents with schizophrenia were found to have a slightly lower IQ than their matched controls. This deficit could be attributed entirely to the male offspring. Using a second comparison group numbering several thousand, we computed correlations for various perinatal and socioeconomic factors with seven-year IQ. These correlations were also computed for the children of schizophrenics, and the difference in correlations was examined. IQs for the offspring of "continuous schizophrenics" (chronic, borderline, and chronic schizo-affective schizophrenics) were found to have lower correlations with socioeconomic indices and higher correlations, in a negative direction, with certain perinatal events. The findings were found to a lesser, nonsignificant degree among the small sample of offspring of acute schizophrenics. If these perinatal events are more negatively correlated with IQ because the children of continuous schizophrenics are specifically susceptible to them, it is possible that these factors are also influential in the later development of schizophrenia.

Acute Disease↗

PubMed1988

Civil commitment in the psychiatric emergency room. III. Disposition as a function of mental disorder and dangerousness indicators.

In 251 evaluations observed in five California public psychiatric emergency rooms, patients who were retained, whether new to the system or having histories of hospitalization, rated higher on measures of danger to self, danger to others, and grave disability than patients who were released. They were also more severely symptomatic and more often given major diagnoses. The combination of dangerousness and mental disorder predicted disposition for 93% of new patients and 88% of recidivist patients. Impulsivity was the most influential aspect of mental disorder.

Adult↗

PubMed1983

The place of abdominal aortography in abdominal aortic aneurysm resection.

We analyzed 110 patients who underwent abdominal aortography as a routine preliminary to abdominal aortic aneurysm resection. In 11 of the 15 patients for whom the procedures were useful in planning the operative tactics, the aortograms would have been performed anyway on clinical indications. In two patients, the changes in surgical maneuvers would not have been made through anatomic inspection at the time of the operations, but the lesions were asymptomatic. Biplane views and views of the femoropopliteal systems were rarely influential. Morbidity from the angiography was minimal and mortality was zero, but about seven aortograms were performed for each one that effected a change in procedure. We concluded that abdominal aortography as a preliminary to aneurysmectomy could be reasonably limited to patients in whom it was indicated by clinical features, including important hypertension, impaired renal function, diminished or absent femoral pulses, suspected mesenteric ischemia, suspected suprarenal extension of the aneurysm, or suspected (from the chest roentgenograms) thoracic aneurysm.

Aorta, Abdominal↗

PubMed1984

Rural rotations for senior surgical residents. Influence on future practice location.

No information is available on factors that influence a surgeon's decision of where to practice. We surveyed all recent graduates of a surgical training residency program from a single institution to determine factors that influence this decision. An attempt was made to determine if a rural rotation during training ultimately influenced surgeons to locate their practices in rural areas. Ninety percent of 58 graduates responded: 44% entered a rural practice and 56% an urban and/or academic practice. A rural rotation during residency had been completed by 64% of the respondents. A significantly larger number of those who entered rural practice had completed a rural rotation than those who entered urban practice. Hometown size, level of debt, and other factors thought to be influential for other subpopulations of physicians were not found to be significant in this review.

Decision Making↗

PubMed1991

Why surgeons prefer not to care for trauma patients.

A survey of the Washington State Chapter of the American College of Surgeons was undertaken to document the opinions of surgeons on trauma care issues. Thirty-nine percent of the total sample of surgeons who responded would prefer not to treat any trauma patients. These surgeons were more likely to be older, to practice in an urban setting, to feel that trauma call has a negative impact on elective practice, and to believe more strongly that reimbursement from trauma patients is not equal to that of nontrauma patients. They also agreed more strongly with the statements that these patients require a greater time commitment and pose an increased medicolegal risk. The most significant influence on preference not to treat trauma patients was exerted by the perception of a negative impact on practice, older age, and perception of increased medicolegal risk. Reimbursement issues and location of practice were less influential factors. This information can be used to target concerns and barriers to active, willing participation in a trauma care system and to tailor strategies to deal with them effectively.

Adult↗

PubMed1986

Genetics and cytogenetics of pediatric cancers.

It is clear that genetic factors play an important role in the development of some human cancers. These factors may be particularly influential in the pediatric age group because environmental exposures have been minimal. Several pediatric solid tumors, including retinoblastoma and Wilms' tumor, are hereditary. Specific constitutional chromosome abnormalities have been found in these patients, thus implicating certain gene regions as being involved in tumorigenesis. Molecular genetic studies have provided insight into the events occurring at the DNA level in these gene regions. The role of genetics in the development of sporadic pediatric malignancies is also beginning to be elucidated as specific acquired chromosome abnormalities are being discovered in the malignant cells of these otherwise karyotypically normal individuals. This paper will review selected hereditary and nonhereditary pediatric cancers that demonstrate the importance of genetic considerations in the diagnosis and management of children with cancer.

Acute Disease↗

PubMed1989

Cytogenetic findings and prognosis in neuroblastoma with emphasis on marker chromosome 1.

The relationship between cytogenetic findings and prognosis in 51 pediatric patients with neuroblastoma is described. Patients were classified into the following four groups based on karyotypic findings: (1) near diploidy, 42 to 47 chromosomes (n = 11); (2) hyperdiploidy, 50 to 56 chromosomes (n = 4); (3) near triploidy, 60 to 77 chromosomes (n = 33); and (4) hypotetraploidy, 80 to 83 chromosomes (n = 3). Patients with near diploid or hypotetraploid karyotypes also had several structural abnormalities including marker chromosome 1, with or without double minutes (DM) or homogeneously staining regions (HSR). Most of these patients were 1 year of age or older and had advanced tumors. The patients who were in the hyperdiploid or near triploid category had few structural abnormalities; all of them, except one, were younger than 1 year of age, had localized tumors, and are long-term, disease-free survivors. Kaplan-Meier analysis of survival rates disclosed a significant difference favoring the latter group (P less than 0.001). N-myc gene amplification was found in five patients of the former group but in no patients of the latter group. The presence or absence of DM or HSR in the former group had no statistically demonstrable effect on survival. However, the presence of marker chromosome 1 appears to indicate a poor prognosis. Five patients with Stage IV-S disease had near triploid abnormalities similar to findings in patients with localized tumors. We propose that localized and Stage IV-S neuroblastomas can be classified as one disease category, and that patients with near diploid or hypotetraploid karyotypes are clinically distinct from those having hyperdiploid or near triploid karyotypes. We consider that chromosomal pattern is a more influential prognostic factor than age, disease stage, or N-myc gene amplification.

Child↗

PubMed1990

A standard dose of radiation for "microscopic disease" is not appropriate.

Elective irradiation of sites of potential occult tumor spread is often part of a patient's radiation therapy program. The required radiation dose (D) depends on the probability that occult disease exists (P(occ)), the number of sites at risk (A), the number of tumor clonogens present (Ni), their radiation sensitivity, and the desired control rate. An exponential model of cell survival is used to quantify the importance of these factors. Control Probability = [1 - Pocc x (1 - e-Ni x (SF2)D/2)]A; SF2 = surviving fraction after 2 Gy. Implications for clinical radiation therapy include: 1. Since the number of clonogens in an occult site may vary from 10 degrees to 10(8), Ni is the major determinant of the required dose. The intrinsic radiation sensitivity of the clonogens (SF2) is also extremely important in determining the dose. Other factors are less influential since they vary less. 2. The variability of Ni (8 logs) is larger than the variation in cell number seen with gross disease (1 cm3 versus 1000 cm3, 3 logs). When Ni approximately 10(8), the required dose approaches that needed for small volume gross disease (10(9) cells, 1 cm3). 3. The dose prescribed to elective sites should reflect the risk of occult disease based on the primary tumor site, stage, and grade. 4. Regions where clinicoradiologic evaluation is difficult (e.g., pelvis and obese neck) require higher doses because macroscopic tumor deposits may exist. 5. Relatively low doses (10 to 30 Gy) are often thought to be inadequate for microscopic tumor. However, similar doses have been reported to sterilize microscopic tumor in ovarian, rectal, bladder, breast, and head and neck carcinomas. Relatively low doses should not be discounted since they may be useful in select cases when normal tissue tolerances and/or previous irradiation treatment limit the radiation dose.

Cell Survival↗

PubMed1979

Training, role models, and research activity among clinical psychologists.

Compared clinical psychologists (N = 270) with high and low publication rates through questionnaire responses. Highs report dissertation experiences more positively influenced their research motivation. Although the most influential professor in both groups was typically clinical, more highs found the professor emphasized another orientation, particularly empirical research, over clinical expertise. Highs report more time available, collaboration opportunities, and organizational acceptance for their research. Both groups favor empirical methods, although highs and lows agree that a small proportion of psychological research makes a significant contribution. Individual preferences probably interact with situational characteristics, both in training and work settings, to determine research activity.

Academic Dissertations as Topic↗

PubMed1988

The Level of Expressed Emotion Scale: a new measure of expressed emotion.

The Level of Expressed Emotion (LEE) scale was developed to provide an index of the perceived emotional climate in a person's influential relationships. Unlike existing measures, the scale was constructed on the basis of a conceptual framework described by expressed emotion theorists. In addition to providing an overall score, the 60-item scale assesses the following four characteristic attitudes or response styles of significant others: Intrusiveness, emotional response, attitude toward illness, and tolerance/expectations. The scale underwent extensive psychometric development procedures: (1) theoretically based item generation; (2) pilot testing with normal and psychiatric populations to select the final items; and (3) construct validation within a schizophrenic population. The results were quite favorable and indicate that the LEE scale has sound psychometric properties of internal consistency; reliability; independence from sex, age, and amount of contacts; and construct validity.

Adaptation, Psychological↗

PubMed1989

The contributions of self-defeating philosophies, perceived helplessness, and repression to anxiety among psychiatric patients.

Four of the most influential psychological explanations for the development of anxiety attribute it to (1) repressed awareness of undesirable emotions; (2) the emergence of unacceptable feelings from the unconscious; (3) adherence to irrational, self-defeating philosophies; and (4) perceived helplessness/lack of control over one's affairs. To test these theories, the authors administered the Trait Anxiety, Denial, Irrational Beliefs, and Locus of Control scales to 190 psychiatric inpatients. Appropriate zero-order, attenuation-corrected, multiple, and partial correlations were run. Denial was correlated negatively with Trait Anxiety; this is consistent with the view that awareness of unpleasant emotions generates anxiety, but does not support the claim that it is the result of repression. The correlations of Trait Anxiety with the Irrational Beliefs scale were substantial. However, its relationships with Locus of Control were limited and nonsignificant after the effects of the Denial and Irrational Beliefs scales were removed statistically. The findings lend support to the positions that anxiety results from self-defeating philosophies and/or the emergence of unpleasant thoughts about oneself, but give only modest support to the "perceived helplessness" hypothesis and seem to contradict the "excessive repression" explanation.

Adjustment Disorders↗

PubMed1989

WISC-R stability and re-evaluation of learning-disabled students.

This study investigated the temporal stability of WISC-R IQ scores for learning-disabled subjects (N = 113). All study subjects were administered the WISC-R for an initial evaluation (M age = 8 years, 3 months) and a follow-up re-evaluation (M age = 11 years, 7 months). Pearson product-moment correlations yielded coefficients that were considerably lower than those previously reported: r = .55, p less than .001 for the Verbal IQs; r = .63, p less than .001 for the Performance IQs; and r = .58, p less than .001 for the Full Scale IQs. Results of t-test analyses indicated that only the Verbal IQ scores were significantly different when the initial evaluation (M = 89.4) was compared to the re-evaluation (M = 85.3), p less than .001. The results suggest that the WISC-R may be less stable for the learning-disabled population than for other groups and that the average 3-year test-retest time lapse was an influential factor in the reduced reliability of this instrument.

Child↗

PubMed1990

Comparisons of two expressed emotion scales with the Camberwell Family Interview.

The relationship of the Camberwell Family Interview (CFI) with two self-report scales purported to measure levels of expressed emotion was assessed. Fifteen schizophrenic patients and 22 of their relatives completed the Level of Expressed Emotion Scale (LEE) and the Influential Relationships Questionnaire (IRQ). The relatives of patients also participated in Camberwell Family Interviews (CFI). Results supported the value of the self-report measures in evaluating the affective environment of patients with schizophrenia.

Adult↗

PubMed1991

The acceptability of behavioral and emotional feedback depending upon valence and structure in personal growth groups.

Forty-eight students participated in a one-time personal growth group. Subjects were assigned to one of eight groups. Exercises were conducted to promote interpersonal contact, followed by feedback sessions. Four groups generated and exchanged feedback among group members. Statement lists were used as feedback in remaining groups. Within each set, one group delivered positive-behavioral; one, positive-emotional; one, negative-behavioral; and one, negative-emotional feedback. Positive feedback was more credible, desirable, and influential for recipients and donors; positive-behavioral feedback in particular was more credible. Donors rated unstructured feedback as more credible than structured feedback, with negative-structured feedback the least credible with donors and recipients. Findings are discussed in terms of research and application.

Adult↗

PubMed1976

Reflections on the golden age of Columbia psychology.

This paper discusses the Golden Age (1920-1940) of the Columbia University psychology department and analyzes some of the sources of its strengths and weaknesses. Much of the credit goes to Robert S. Woodworth, the dean of American experimental psychology, who set up the objective eclectic orientation of the department, recruited a remarkable group of competent faculty members, and above all kept up a cooperative unified spirit in the department. Because the Columbia University psychology department was so influential during its Golden Age, its organization, staffing and departmental characteristics are analyzed. Probably the key to its success was the capability of a guiding genius, Robert S. Woodworth, who gathered a remarkable group of scholars about him. Woodworth's objective eclectic orientation provided the broadest possible approach within a rigorous experimental-statistical orientation. Woodworth's scholarly approach pervaded the department so that many of his colleagues also wrote pioneering encyclopedic works in their particular fields of specialization. The writings of the Columbia psychologists truly shaped the field.

Faculty↗